A good patient intake form template does two jobs. It collects what you need before the first appointment, and it stops your team asking for the same details at reception, in the treatment room, and again at billing. This version is built for Australian Allied Health practices. It has a copyable template, a fictional example, and notes on keeping intake, treatment consent, and privacy information separate.
Who this Allied Health intake form template is for
It suits physiotherapists, occupational therapists, speech pathologists, psychologists, counsellors, dietitians, and exercise physiologists, from solo practitioners to group practices. Treat it as a starting point. The Australian Health Practitioner Regulation Agency (AHPRA) says registered practitioners must meet their National Board's record keeping expectations and consider state, territory, or Commonwealth health records and privacy laws. Self-regulated professions should also check their professional association's standards.
Start with this client intake form template
Knowing which information needs to be captured at intake is a skill. Ask too much and you risk parts being skipped. Ask too little and you might be missing critical information. To help you find a workable middle ground, we recommend copying these fields into your own form. The status column shows which fields to require, which to make optional, and which to tailor.
| Section | Field | Status |
|---|---|---|
| Client details | Full legal name | Required |
| Preferred name and pronouns | Optional | |
| Date of birth | Required | |
| Mobile phone and email | Required | |
| Residential address | Tailor to your practice | |
| Preferred contact method (SMS, email, or phone) | Required | |
| Emergency contact | Name, relationship, and phone number | Required |
| Reason for booking | What would you like help with? | Required |
| Referrer name, practice, and contact details | If applicable | |
| Referral letter attached | If applicable | |
| Funding | How will your sessions be paid for? * | Required |
| Relevant health information | Health conditions relevant to this booking | Tailor to your practice |
| Current medications | Tailor to your practice | |
| Allergies or sensitivities | Tailor to your practice | |
| Other practitioners involved in your care | Optional | |
| Communication and access | Preferred language or interpreter needed | Optional |
| Accessibility or support needs | Optional | |
| Support person attending | Optional | |
| Acknowledgement | I have read the practice's privacy collection notice (link or attached copy) | Required |
| Signature and date | Required |
(* Self-funded, private health insurance, Medicare, National Disability Insurance Scheme (NDIS), Department of Veterans' Affairs (DVA), workers' compensation, or other)
What each essential field is for
The Australian Privacy Principles (APPs) are regulated by the Office of the Australian Information Commissioner (OAIC). Under APP 3.2, an organisation must not collect personal information (other than sensitive information) unless it is reasonably necessary for its functions or activities. APP 3.3 adds a consent requirement for sensitive information, unless an exception applies.
For health information, the OAIC says a provider can collect it if the client consents, expressly or impliedly, and it is reasonably necessary. That generally means providing a health service to that client. Here is why each essential field captures the information it does:
- Client details: identify the client, avoid duplicate records, and send reminders.
- Emergency contact: someone to call if the client becomes unwell during a session.
- Reason for booking: helps the practitioner prepare and shows whether the booking suits your service. Ask for it in the client's own words.
- Referrer details: lets you send reports back and keep referral paperwork together.
- Funding: tells reception how to invoice before the first session.
- Acknowledgement: records that the client was shown your privacy collection notice.
Which fields should be optional or tailored?
Make a field optional when you don't need it from every client, and tailor fields that depend on your profession or funding mix. Health questions are the main example, so keep them short at intake and leave the detailed history for the first session and your progress notes.
- Psychologists: the Code of conduct for psychologists says clients should be adequately informed about how their information will be recorded, stored, and used before it is collected. Give them your confidentiality information before the form, not after it.
- Paediatric practices: add parent or guardian details, who can make decisions, and who can attend sessions.
- NDIS providers: NDIS providers should confirm five core categories of participant details at intake: personal information, NDIS plan logistics, representative contacts, medical/disability context, and safety risk profiles.
- Workers' compensation and DVA clients: Add claim or file reference fields that appear only when that funding type is selected.
- Physiotherapists and exercise physiologists: add an optional field for the activities the client wants to return to.
An example of a completed intake form
To put the above information in context, here’s a filled out form using the details of a fictional client - Alex Morgan. Every detail below is a placeholder and is purely for illustrative purposes.
| Field | Response |
|---|---|
| Full legal name | Alex Morgan |
| Preferred name | Alex |
| Date of birth | 14 March 1990 |
| Mobile and email | 0400 000 000, alex.morgan@example.com |
| Preferred contact method | SMS |
| Emergency contact | Chris Morgan, partner, 0400 000 001 |
| What would you like help with? | Lower back pain that makes long days at my desk hard. I'd like an assessment. |
| Referrer | Self-referred |
| Funding | Private health insurance, claiming on the day |
| Relevant health conditions | None diagnosed |
| Current medications | None |
| Allergies | None known |
| Other practitioners | GP, Dr Example, Example Medical Centre |
| Communication and access | English, no interpreter needed. Ground-floor room preferred if available. |
| Acknowledgement | Ticked. Signed 3 March 2027. |
In this example, there are no Medicare details because the visit isn't Medicare funded. There’s also no long medical history because the practitioner will collect that information in session.
How is intake different from treatment consent?
Intake collects the facts you need to book, bill, and prepare. Treatment consent is the client's agreement to a proposed assessment or intervention. Consent to information handling is a third matter, so a signature on an intake form shouldn't be read as agreement to all three.
The OAIC's Guide to health privacy says its use of 'consent' covers decisions about how a provider handles health information, not consent to receiving treatment. It lists the elements of consent: the person is adequately informed, consents voluntarily, has capacity, and gives consent that is current and specific. In our view, a single blanket signature is hard to square with the last two. Consent can also be express or implied.
Your privacy collection notice is a separate obligation. APP 5 requires reasonable steps to tell clients about matters including your identity and contact details, the purposes of collection, the consequences if information isn't collected, your usual disclosures, your privacy policy, and any likely overseas disclosures. Under APP 5.1, this happens at or before collection, or as soon as practicable afterwards. The OAIC's Privacy in Practice module says a notice can sit on the form itself, as long as the person can keep a copy or find it elsewhere, such as a webpage.
A practical setup uses three documents: the intake form, a privacy collection notice linked from it, and treatment consent recorded by the practitioner. This is a choice for clarity. It isn't a stated OAIC requirement.
Reviewing data collection and accessibility
The OAIC describes "reasonably necessary" as an objective test: whether a reasonable person who is properly informed would agree that the collection, use, or disclosure of personal information is necessary in the circumstances. Your practice has to be able to justify it.
The current APP 3 guideline (Version 1.2, May 2026) lists, among the relevant factors, whether you could undertake the function or activity without collecting specific personal information, or by collecting a lesser amount of personal information
Information should generally come directly from the client unless that is unreasonable or impracticable. As a standard operating procedure, run this check once a year:
- Could you deliver the service without this field, or with less detail?
- Is every question in plain language?
- Does the form work on a phone?
- Can clients ask for another format, or complete it with a support person or interpreter?
- Are optional fields clearly marked?
- Can clients easily find and keep a copy of your privacy notice?
For NDIS participants, the NDIS Practice Standards indicators say each participant is advised of confidentiality policies in the language, mode of communication, and terms they're most likely to understand.
Moving from downloadable forms to online intake
A downloadable form works, but someone still retypes it into the client file, and that's where typos and missed fields creep in. It won't import automatically into any system, so the next step is rebuilding your chosen fields as an online form.
In splose, customisable online forms let clients complete intake before their first appointment, so details land in their record without retyping. If new enquiries come through your website, our article on embeddable forms and the waitlist screener explains how that front door can work, and the waitlist and triaging page has the details.
Frequently asked questions
What information belongs in an Allied Health intake form?
Include client details, an emergency contact, the reason for booking, referrer details, funding type, a short set of relevant health questions, and access needs. Add an acknowledgement that the client has seen your privacy collection notice. Leave out anything you can't justify as reasonably necessary for the service.
Can an intake form act as consent to treatment?
It shouldn't. Treatment consent covers a proposed assessment or intervention, and the practitioner is best placed to discuss and record it. The OAIC's health privacy guidance treats consent to information handling as separate from consent to treatment.
How long should we keep completed intake forms?
It depends on your state or territory. In Victoria, a private provider can't delete health information until seven years after the last service, or until the person turns 25 if they were last treated under 18. In NSW, private providers keep an adult's health information for 7 years from the last service. Health information collected while a person was under 18 must be held in NSW until the individual turns 25 years old. The 7 year hold also applies to health information in QLD, SA, WA, Tas, NT, and the ACT.
Do NDIS participants need a different intake form?
Usually a variation of the same form. The NDIS Practice Standards indicators say participants should understand and agree to what personal information is collected and why, including recorded audio or visual material, so make that explicit.
Intake forms can be a powerful tool if used judiciously
A short, purposeful intake form is easier for clients to finish and easier for your team to use. Start with the template, cut what you don't need, keep consent and privacy information separate, and review it each year.
